NeCara McClendon was 19 weeks pregnant when she came home from get off work on a Tuesday night in August 2022 when she started bleeding profusely.
At the nearest emergency room in Fredericksburg, Va., where she lives, paramedics told her her cervix was dilating. Her baby and amniotic sac entered the birth canal prematurely.
One doctor told her there was no hope, a second said she needed a specialist consultation, and a third advised a transfer via telemedicine and a technique that left the mother with her head down in a hospital bed trying to avoid a miscarriage.
The mixed message is frustrating, McClendon said. “It felt like they kept giving me a little bit of hope and then took it away.”
After the transfer, McClendon discovered that the new hospital did not offer tilt treatment. Instead, they gave her medicine and told her to wait. She did it for 3 days before the ultrasound showed her son’s leg was in the birth canal.
The doctor said there was nothing that could be done. McClendon gave birth to her son the next morning at 19 weeks and five days, too young to survive outside the womb.
“The days that followed kept crying—asking [myself] Why is this happening to me. I started to feel like a failure. “
why does it happen
Miscarriage is more common than many people think.it happens around a quarter Pregnancy, usually in the first trimester. It’s often not clear why it happened.
Still, there are certain things that can increase your risk of miscarriage. Weight is one of them, with McClendon being slightly overweight. She also has polycystic ovary syndrome (PCOS), which means her ovaries produce too much male sex hormones, called androgens. PCOS increases the risk of early miscarriage in the first trimester of pregnancy. (McLendon didn’t lose her son until nearly the fifth month.)
But there was another factor: McClendon was black.
In the United States, black women are 43 percent more likely than white women to have a miscarriage, according to a 2021 study of more than half a million American women. (Black mothers are also more likely than white mothers to lose their babies, or their lives, at 20 weeks or after delivery (stillbirth), according to the CDC.)
“The scandal is that we don’t really know [why],” said the study’s lead author, Siobhan Quenby, MD. “We urgently need more research. Not knowing is unacceptable in 2022. ”
Doctors do know that health risk factors for miscarriage, such as diabetes, obesity and high blood pressure, are more common in black women than in white women.
But again, the question is why? Factors include differences in biology, society, culture, lifestyle and healthcare. According to experts, these are difficult to separate.
Other less-studied biological factors may also play a role. For example, fibroids — muscle tumors that grow on the wall of the uterus — can sometimes cause miscarriages. Almost 25 percent of black women ages 18 to 30 have the disorder, compared with 6 percent of white women. Black women are also two to three times more likely to develop fibroids or complications, which can exacerbate the problem.
Differences in the vaginal microbiota of black and white women may be involved, as the vaginal microbiota is associated with recurrent miscarriage.
But disparities in access to and use of health care are likely to have the biggest impact, says Ana Langer, MD, director of the Women’s Health Initiative at the Harvard TH Chan School of Public Health.
Black women are less likely to seek adequate prenatal care for a variety of reasons, Lange said. These may include lack of insurance, lack of financial and educational resources, lack of nearby medical facilities, fear of abuse, and more. Several studies have shown that even society-wide racist beliefs can delay prenatal care.
The effect of race on the healthcare setting is difficult to explain. In one striking study, the death rate of black newborns in the United States was three times higher than that of white newborns, but their mortality rate was cut in half when they were cared for by black doctors. But strangely, the study found that physician race did not affect mothers’ outcomes. Researchers continue to study these questions.
Since August, McClendon and her partner have been trying to find an in-person grief counselor they can see as a couple. But so far, they’re out of luck. So they’ve been working their own way — and with some success. “I wouldn’t say it’s going to get better, but you’re going to be better at handling it,” she said.
The grief came in waves, she said. Some days they are fine, other days the pain returns unexpectedly. The approaching of the baby’s due date can be especially difficult.
“Last Saturday was supposed to be my baby shower,” McClendon said. What was supposed to be a day to celebrate McClendon and her future son became a day to remember what she had lost. This is a tough day. But she survived. “It was sad at first, but it got better in the end,” she said.